Provider Demographics
NPI:1972612828
Name:PATHOLOGY ASSOCIATES
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAYICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-264-1171
Mailing Address - Street 1:PO BOX 140987
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0987
Mailing Address - Country:US
Mailing Address - Phone:907-345-0004
Mailing Address - Fax:907-561-1953
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-264-1171
Practice Address - Fax:907-264-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK33825207ZP0102X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Not Answered291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGRO825Medicaid
AKGRO825Medicaid